NIMODIPINE IN LITHIUM-REFRACTORY BIPOLAR PATIENTS

钙通道阻滞剂尼莫地平在情感性心力衰竭中的应用 精神障碍是基于几个经验和理论基础的。这个 L类钙通道阻滞剂维拉帕米已被报道有效 治疗急性躁狂症但不治疗抑郁症，而尼莫地平有 与维拉帕米的疗效不同。它的脂肪含量更高 溶解并阻断可卡因引起的多动和多巴胺溢出 在几个模型体系中也是较好的抗惊厥剂。正性 对尼莫地平的反应在五名患者中有一人观察到 快速但不是超传统的自行车障碍，这在一项关于 开关(B-A-B)设计。3例超高速骑行患者 (超级自行车)对双人自行车表现出完全或部分反应- 盲目使用尼莫地平。部分应答者已确认 在B-A-B设计中实现了更完整的响应 添加卡马西平。自从卡马西平最近被 被描述为通过NMDA受体抑制钙内流 小脑颗粒细胞，这些数据增加了药物 对钙通道有不同影响的可能对难治性疾病有用 病人。1例复发的短暂抑郁症患者有反应 戏剧性地对尼莫地平的盲目机构，对安慰剂复发 替代，并以活性药物的重新制度(B-A-B- A)；这位患者在维拉帕米治疗后继续表现出改善 用来替代尼莫地平。这些数据表明，进一步 尼莫地平治疗屈光不正情感障碍的临床研究 疾病和钙代谢改变的可能性 生病了。

Utilization of the calcium channel blocker nimodipine in affective disorders is based on several empirical and theoretical rationales. The L-type calcium channel blocker verapamil has been reported effective in the treatment of acute mania but not depression, and nimodipine has a different profile of effects compared with verapamil. It is more lipid soluble and blocks cocaine-induced hyperactivity and dopamine overflow and is also a better anticonvulsant in several model systems. Positive response to nimodipine has been observed in one of five patients with rapid but not ultradian cycling disorder and this was confirmed in an on- off-on (B-A-B) design. Three patients with ultra-ultra rapid cycling (ultradian cycling) showed complete or partial responses to the double- blind administration of nimodipine. The partial responder was confirmed in the B-A-B design and a more complete response was achieved with the addition of carbamazepine. Since carbamazepine has recently been described to inhibit calcium influx through the NMDA receptor in cerebellar granule cells, these data raise the possibility that drugs with differential effects on calcium channels may be useful in refractory patients. One patient with recurrent brief depression responded dramatically to the blind institution of nimodipine, relapsed on placebo substitution, and re-responded with reinstitution of active drug (B-A-B- A); this patient continued to show improvement when verapamil was substituted for nimodipine. These data suggest the utility of further exploring the clinical profile of nimodipine in refractor affective disorders and of the potential of altered calcium metabolism in this illness.